Could a Virtual Clinic Improve the Quality of Physical Health Monitoring for Safe Antipsychotic Prescribing in an Older Adult Community Mental Health Team (CMHT)? Encouraging Preliminary Results From a CMHT in Wales

Aims Antipsychotics are linked to increased cardiometabolic risk. The National Institute for Health and Care Excellence (NICE) the Royal College of Psychiatrists have developed guidance on PHM mitigate this Both risks age-blind, very relevant Older Adults due age-related increase in cardiovascular COVID-19 pandemic boosted digital healthcare, which remains rocketing demand stretched services. This is a Quality Improvement Project aiming improve physical health monitoring (PHM) safe antipsychotic prescribing an Adult Community Mental Team South Wales. Baseline data, virtual clinic model preliminary results first Plan-Do-Study-Act cycle presented. Methods An audit was conducted (06/2021–12/2021), with continuous prospective data collection thereafter. A scoping exercise establish available resources. local protocol/operational framework developed. Education interventions (03/2022-on-going), junior-doctor-led phlebotomy/electrocardiogram (ECG) pathway (10/2022-on-going) were designed implemented. Results (06/2021-09/2022): completed lifestyle advice=0%, observations=3%, blood tests=3%, ECG=3% eligible patients. No patient (0%) had full as per guidance. Mean overall compliance guidance/patient=9%. Pareto chart: no clear lack prescriber awareness main reasons (>95%) poor performance. Scoping exercise: Health-Board/Trust-wide approach problematic all localities. General Practitioners assertive regarding responsibility/funding deliver at least 12 months or until dose mental state stable. Geriatric teams, district nurses, general adult teams unable support. home staff training Phlebotomy ECG departments hospitals could support but pathway. First PDSA (preliminary): Change idea 1: education: shift (04/2022 onwards). Proportion trained reached 100% December 2022, January 2023. 2: (10/2022 01/2023) – mean guidance/patient = 69% (vs. 9% baseline). patients complete 50% 75% response rate. 3: phlebotomy/ECG proportion bloods done 67% Conclusion Preliminary suggest encouraging trend significant improvement which, from clinical perspective, already significant. However, more required draw conclusions cost effectiveness clinic.